Subcutaneous local anesthesia versus intravenous regional anesthesia for endoscopic carpal tunnel release: a randomized controlled trial.

OBJECT: This study compares the effectiveness of subcutaneous infiltration of a local anesthetic agent (LA) versus intravenous regional anesthesia (IVRA) during endoscopic carpal tunnel release. METHODS: Forty-four patients suffering from severe symptoms restricting normal daily activities-such as persistent loss of feeling in the fingers or hand, or no strength in the thumb in spite of prolonged nonsurgical treatment-and with electromyographically proven carpal tunnel syndrome were enrolled in this study. All underwent endoscopic carpal tunnel release. Twenty-two patients had an endoscopic release of the median nerve under LA (LA Group). The other 22 patients underwent the surgery after intravenous induction of regional anesthesia (IVRA Group). The operating room in-out time and tourniquet time were evaluated in both groups. The patients were also asked to evaluate the pain associated with the tourniquet during surgery using a visual analog scale. The Michigan Hand Outcomes Questionnaire was used to assess the functional outcome preoperatively and at both 2 weeks and 6 months postoperatively. RESULTS: One patient in the LA Group needed an additional application of prilocaine, whereas 3 patients in the IVRA Group needed additional LA and 1 of these required propofol. The tourniquet time and operating room time were significantly lower in the LA Group (p = 0.01 for both). There were no complications related to the endoscopic surgery. The Michigan Hand Outcomes Questionnaire did not show significant differences between the groups at either postoperative follow-up examination. CONCLUSIONS: Endoscopic carpal tunnel release with subcutaneous infiltration of LA was well tolerated and effective. Injection-associated problems such as increased thickness of the synovial layer or impaired endoscopic view did not occur.

Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness.

BACKGROUND: Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988) can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. PURPOSE: The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. METHODS: 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS) (ranging from 0 = no pain to 10 = maximum pain). RESULTS: One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min). The pain score related to injection was 2.5 (0.8) and to tourniquet was 3.6 (0.9). Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. CONCLUSION: Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.